Should all breast cysts be biopsied? At what diameter should we become concerned?
—Filia Garcia, MD, San Juan, P.R.

National Comprehensive Cancer Network guidelines recommend that simple cysts which are asymptomatic can be followed for two to four months before intervention. Cysts that are not simple or are causing symptoms warrant aspiration. If bloody fluid is obtained, surgical excision or ultrasound-guided biopsy is advised. If the fluid is blood-free, follow-up examination in two to four months is warranted. With an irregular cyst wall or intracystic mass, surgical excision should be performed. The size of the cyst alone should not be a determining factor.
—Michael J. Flamm, MD, assistant professor of clinical medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York City (121-7)